FODMAPs

Question 1

What does FODMAP stand for?

Answer 1

Fermentable Oligosacchardies, Disaccharrides, Monosaccharides and Polyols

Question 2

Oligosacchardies - Fructans

Answer 2

Chain of fructose molecules with a glucose terminal end (varying length)
Sub-groups of fructans:
Fructo-Oligosacchardie (<10)
Oligofructose (2-8)
Inulin (2-60)

Question 3

Oligosacchardies - Fructans (digestion and absorption)

Answer 3

Poorly absorbed in all people
Lack of enzyme to break B2-1 bond
Pass through small intestine
Readily fermented by gut bacteria in large intestine

Question 4

Oligosacchardies - Fructans (average intake in UK)

Answer 4

4g/d (3.6g/d IBS)

Question 5

Oligosacchardies - Galacto-Oligosacchardies

Answer 5

Chain of galactose molecules with a sucrose terminal end
Raffinose (1 ga)
Stachyose (2 ga)
Verbascose (3 ga)

Question 6

Oligosacchardies - Galacto-Oligosacchardies (digestion and absorption)

Answer 6

Poorly absorbed in all people
Lack of enzyme a-galactosidase
Pass through small intestine completely intact
Readily fermented by gut bacteria in large intestine

Question 7

Oligosacchardies - Galacto-Oligosacchardies (average intake UK)

Answer 7

2g/d IBS

Question 8

Disacchardies - Lactose

Answer 8

Two sugar unit
Glucose + galactose

Question 9

Disacchardies - Lactose (digestion and absorption)

Answer 9

Poorly absorbed in some peoples due to lack of enzyme lactase
Lactase hydrolyses lactose into monosaccharides
Osmotic pull - draws water into small intestine as it moves through
Fermented by gut bacteria in large intestine

Question 10

Disacchardies - Lactose (deficiencies)

Answer 10

Primary lactose deficiency - genetic fault
Secondary lactase deficiency- due to illness or injury
Developmental - premature babies
Congenital - genetic fault

Question 11

Disacchardies - Lactose (average intake UK)

Answer 11

7g/d IBS

Question 12

Monosaccharide - Fructose

Answer 12

One sugar unit

Question 13

Monosaccharide - Fructose (digestion and absorption)

Answer 13

Passes through gut via GLUT5 receptor
Capacity for absorption is variable
Not well absorbed in small intestine
Draws in water as moves down gut
Majority makes it to large intestine where it is fermented by bacteria
Glucose aids absorption of fructose in small intestine via GLUT2 receptor

Question 14

Monosaccharide - Fructose (average intake UK)

Answer 14

17g/d IBS

Question 15

What is considered a high fructose load in one sitting?

Answer 15

More than one handful of safe fruit
Fruit juice
Dried fruits in large amounts
Added fructose
Foods high in sucrose (e.g. fizzy juice)

Question 16

Polyols - sugar alcohols

Answer 16

Hydrogenated carbohydrates
Alcohol group
Predominantly monosaccharides
Disaccharides

Question 17

Polyols - sugar alcohols (digestion and absorption)

Answer 17

Some absorbed in small intestine via passive absorption only
Absorption affected by intestinal transit time
Tolerated in low concentration but at high concentrations won’t be very well absorbed
Certain types may be tolerated better

Question 18

Polyols - sugar alcohols (average intake UK)

Answer 18

<1g/d IBS

Question 19

Symptoms caused by FODMAPS

Answer 19

Motility changes
Bloating
Pain and discomfort
Wind

Question 20

Cut off for high FODMAP

Answer 20

Fructans >0.2g per portion
Lactose >4g per portion
Fructose >0.5g in excess of glucose per 100g or >3g per portion
Polyols >0.3g per portion

Question 21

3 stages of FODMAP diet

Answer 21

Restriction
Reintroduction
Personalisation (long-term management)

Question 22

Some people may not need to restrict … and … as bodies can absorb these quite well

Answer 22

Lactose or fructose

Question 23

Two approaches of low FODMAP diet - Top down

Answer 23

Restrict FODMAPS for 4-8 weeks
Reintroduction of foods to find personal tolerance
Emphasis on return to normalised diet

Question 24

Two approaches of low FODMAP diet - Bottom up

Answer 24

Reduce specified high FODMAP foods
Restriction over a set period
Further restrictions only used if no improvements of symptoms in response

Question 25

Maintain balanced dietary intake on low FODMAP diet

Answer 25

Consume enough fibre Drink enough water Min 5 fruit or veg portions per day Base meals on starchy carbohydrates Include lean protein sources Include calcium rich foods Limit processed products 30g fibre may lead to constipation

Question 26

It is important to reintroduce FODMAPS to …

Answer 26

Identify which FODMAPS are triggers Identify quantity of FODMAPS tolerated or not tolerated Ensure a varied gut healthy diet

Question 27

How reintroduction should be done…

Answer 27

Gradual food challenges over 6-10 weeks Choose a food to reintroduce Keep to low FODMAP diet until minimal symptoms 3 days before challenge of new food Avoid eating out during 3 challenge days as more difficult to be sure diet is low in other FODMAPS Keep other possible symptom triggers to a minimal Use same food for each of 3 challenge days ensure minimal or no symptoms before next challenge

Question 28

FODMAP challenge

Answer 28

Day 1 - eat challenge food Symptoms - stop No symptoms - day 2 Day 2 - double food challenge portion from day 1 Symptoms - stop No symptoms - day 3 Day 3 - triple food challenge portion from day 1 Symptoms - wait for 3 days without symptoms No symptoms - commence next food challenge

Question 29

Challenges based on FODMAP foods - fructans

Answer 29

Need to challenge with each fructan containing food Challenge with one fructan containing food as separate 3 day challenge

Question 30

Challenges based on FODMAP foods - galato-oligosaccharides

Answer 30

Challenge with only one food Don’t use hummus or baked beans as contain other FODMAPS Symptoms avoid all GOS foods completely No symptoms all GOS can be tolerated

Question 31

Challenges based on FODMAP foods - fructose

Answer 31

Challenge with honey or mango Symptoms avoid all foods high in fructose No symptoms fructose foods should be tolerated well

Question 32

Challenges based on FODMAP foods - Polyols

Answer 32

Challenge with 2 Polyols - sorbitol and mannitol One may be tolerated or both may be Challenge separately Same food item for all 3 days of food

Question 33

Challenges based on FODMAP foods - lactose

Answer 33

One challenge required Cows milk or yogurt Only needed if deemed necessary Avoid if symptoms Semi skimmed or full fat

Question 34

Considerations

Answer 34

Many foods with multiple FODMAPS Introduce foods with several FODMAPS only when challenge is completed in full Have smaller portions to keep an eye on symptoms

Question 35

Other foods that may be teuffwes for unwanted gut symptoms

Answer 35

Caffeine Chilli Alcohol Fatty foods

Question 36

Personalisation

Answer 36

Can only occur if stage 1 and 2 challenges are correctly followed Tolerance level is personal Trigger foods as part of a meal can be tolerated better Trigger foods don’t cause damage to the gut Follow balanced diet Apps and online resources Enzymes may help in some cases